Social Anxiety Disorder is a term synonymously used for Social phobia; it can be defined as “a marked persistent fear of one or more social or performance situations involving exposure to un-familiar people or possible scrutiny by others”. Mainly the fact and underlying etiological determinants are the potential criticism, humiliation, or negative evaluation by others that is considered the source of anxiety among individuals who are experiencing social phobia in one or other occasions. Excessive self-consciousness and self-criticism are factors that pave way to severe sort of phobic avoidance. Significant distress or interference in living activities or cardinal performance oriented functions is finding to be the key to the diagnosis of social phobia.

Keywords: Social anxiety disorder, Fear, Self esteem

INTRODUCTION

According to Anxiety and Depression Association of America about 15 million American adults have social anxiety disorder with a prevalence of 6.8%. The typical age of onset is 13 years of age, 36 percent of people with social anxiety disorder report symptoms for 10 or more years before seeking help. The anxiety can interfere significantly with daily routines, occupational performance or social life, making it difficult to complete school, interview and get a job, and have friendships. Social anxiety disorder usually begins in childhood or adolescence and children are prone to clinging behavior, tantrums and even mutism [1-3].

Social phobia is found very common among the academic society and student population having education ranging from primary schools to post graduation rendering institutes, about 19 to 22% of undergraduate students suffered from the same and the incidence rate of social phobia during lifetime has increased from 4.2 to 16% in general population [4].

Self-esteem has been regarded as a judgment of oneself as well as an attitude toward the self. It encompasses beliefs (for example, “I am competent”, “I am worthy”) and emotions such as the feeling of triumph, despair, pride and shame [5]. “The self-concept is what we think about the self; self-esteem is the positive or negative evaluations of the self, as in how we feel about it” It has been reported that self-esteem begins to form in early childhood and factors that can influence it include: thoughts and perceptions of oneself, reaction from other people, experience at home, school, work and in the community, illness, disability or injury, culture or religion, role and status in society. Others are media, feedback, consequences/happenings, handling, success and popularity [6].

About 30% of student nurses suffer from anxiety especially in specific situations including: test, examination and presentations. The unfavorable effects of social experienced by nursing students will gradually pave way to the development of disturbance in the level self-esteem over a period of time which in turn may adversely affects their academic performance in future, as nursing is a skill and practice oriented profession rather than acquiring theoretical knowledge it marks a unfavorable note of this relationship [4].

The aspects of self-esteem and social phobia in Nursing are areas where there is dearth of research. In Sociology and Psychology, self-esteem reflects a person’s over all emotional evaluation of his or her own worth [7]. Inferentially, one’s judgment of himself/herself (in a self-conscious state) perception of people’s negative evaluation leads to perceived inadequacy in social performance. This occurs     alongside     doubts     for     gaining     satisfactory commendation/impression in real or imagined social evaluation circumstances. Without this, social phobia does not ensue and a healthy self-esteem is formed.

MATERIALS AND METHODS

A correlational study was conducted on social anxiety and self-esteem among nursing students in selected nursing colleges at Trivandrum district, with objectives to assess self-esteem and social anxiety among nursing students and to determine the correlation between social anxiety and self-esteem. The study followed a quantitative research approach using a descriptive correlational research design. Study was conducted at two prominent nursing colleges of Trivandrum district in State of Kerala. 418 nursing students were recruited using total enumeration sampling technique hence an acquisition of non-probability sampling design. Ethical clearance was obtained from the institutional ethical committee and obtained formal permission from the head of institution from selected nursing colleges. Informed consent was obtained after ensuring confidentiality of the data. Tools and techniques used were a Socio demographic proforma which collects baseline data regarding subjects, such as; age, sex, year of study, previous pattern of education ,medium of previous pattern of education, Educational level of father ,educational level of mother ,father’s occupation ,mother’s occupation and presence of any comorbidities. Rosenberg self-esteem scale is a standardized tool with ten items self-report instrument for assessing level of self-esteem. The items are answered in four point likert scale ranging from options strongly agree to strongly disagree. The scale ranges from 0 to 30 scores in that 15 to 25 are in normal range; score below 15 suggest low self-esteem. Researcher developed social anxiety scale is an instrument used to measure the level of social anxiety a person experiences. This was a 24 item questionnaire with four point likert scale. The scale classifies level of social anxiety with scores 55 to 65 as moderate social anxiety, 65 to 80 as  marked social anxiety, 80 to 95 as severe social anxiety and 95 and above very social anxiety. Both Rosenberg self-esteem scale and social anxiety scale are standardized tools. Rosenberg self-esteem scale has reliability of 0.77 and later has reliability of 0.94. BSc nursing students in selected nursing colleges will be the sample, recruited using total enumeration sampling technique. As per the formula 4pq/d² and prevalence (16%) from a previous study conducted in Bangalore which determines the sample size as 418. Data was entered and analyzed using SPSS V20.0 and appropriate statistical techniques were used to meet the objectives.

RESULTS

The results are shown in Tables 1-4.

DISCUSSION AND CONCLUSION

Students from professional Nursing courses are especially demanded at practical skills, such as performing invasive procedures with venous punctures, bandaging, hygiene, and comfort care in patients with different degrees of illness. Throughout the course, nursing students are confronted by situations that generate psychological pressure and anxiety. Nursing as a social profession, needs more social interactions. Nurses should be able to develop therapeutic interaction with patients. This would be possible only when they are confident and concerned for others and free of anxiety disorders. Hence it brings relevance to research upon anxiety related disorders among nursing students. Our study reveals that 70.3% of subjects had mild social anxiety, 22% had moderate, 7.7% had marked and none of them is having severe and very severe social anxiety. Our study reveals that 12.9% of subjects had low self-esteem, 84.7 % had normal and 2.4% had good self-esteem, both self-esteem and social anxiety levels are in accordance with various studies published worldwide [10-12]. There was no significant correlation between social anxiety and self-esteem among nursing students in this study. Nurses should teach parents and teachers about the identification and management of social anxiety and low self-esteem. Nurses should be able to rule out socially anxious clients and to identify symptoms in clinical practice. Encourage further studies on assessment of social anxiety and self-esteem among various professional students and more research should be conducted on various psychological and nursing interventions for the management of social anxiety and low self-esteem. Improve facilities for identification and supportive management of patients with social anxiety in various settings and also provide opportunities for nurses to attend training programs in Identification and management of social anxiety.

LIMITATIONS OF THE STUDY

·         Interaction time with subjects was comparatively less.

·         Setting was limited only to private nursing colleges.

·         Social anxiety disorder as such couldn’t be identified according to ICD/DSM criteria due to time constraints in data collection time period.

ETHICAL CONSIDERATIONS

Written consent was obtained from college authorities, from Institutional Ethical Committee and informed consent from subjects prior to the study.

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